Provider Demographics
NPI:1104383181
Name:FENIX MENTAL HEALTH GROUP LLC
Entity Type:Organization
Organization Name:FENIX MENTAL HEALTH GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DUNIA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-542-9914
Mailing Address - Street 1:3237 NW 7TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4137
Mailing Address - Country:US
Mailing Address - Phone:786-542-9914
Mailing Address - Fax:786-542-9933
Practice Address - Street 1:3237 NW 7TH ST STE 101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4137
Practice Address - Country:US
Practice Address - Phone:786-542-9914
Practice Address - Fax:786-542-9933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-26
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management